| |
|
|
Points |
| 1 |
Do you currently smoke? |
yes/no |
5 |
| 2 |
Have you been a smoker for more than 3 years? |
yes/no |
3 |
| 3 |
Do you have mercury filings? |
yes/no |
4 |
| 4 |
Do you regularly use household chemicals for cleaning,
disinfecting, deodorizing, carpet cleaning, oven cleaning, stain
removals? |
yes/no |
2 |
| 5 |
Do you drink unfiltered water? |
yes/no |
2 |
| 6 |
Do you live in an urban environment? |
yes/no |
3 |
| 7 |
Do you consume alcohol? |
yes/no |
3 |
| |
Have you ever lived:
|
|
|
| 8 |
within 10 miles of a nuclear power plant? |
yes/no |
4 |
| 9 |
within 5 miles of a toxic waste dump? |
yes/no |
5 |
| 10 |
near a farm where aerial pesticides
are used? |
yes/no |
5 |
| 11 |
on a farm where pesticides are sprayed? |
yes/no |
5 |
| 12 |
Do you have asbestos in your house, work place, or school? |
yes/no |
3 |
| 13 |
Do you consume fast foods? |
yes/no |
2 |
| 14 |
Have you ever worked professionally with pesticides
or chemicals? |
yes/no |
4 |
| 15 |
Do you have your clothes cleaned with professional dry cleaning? |
yes/no |
1 |
| 16 |
Has your home been treated for termites in the past 10 years? |
yes/no |
1 |
| 17 |
Do you consume non-organically grown fruits
and vegetables? |
yes/no |
2 |
| 18 |
Do you live in an area where the ground is known to contain radon
gas? |
yes/no |
3 |
| |
Do you exhibit any of the following symptoms: |
|
|
| 19 |
Feel fatigued for no apparent reason? |
yes/no |
2 |
| 20 |
Feel lifeless, depressed? |
yes/no |
2 |
| 21 |
Feel lightheadedness from time to time? |
yes/no |
1 |
| 22 |
Have difficulty thinking clearly? |
yes/no |
1 |
| 23 |
Do you suffer from aches
and pains for no apparent reason? |
yes/no |
3 |
| 24 |
Do you sometimes feel irritable for no reason? |
yes/no |
2 |
| 25 |
Do you sometimes feel anxious
for no reason? |
yes/no |
2 |
| 26 |
Do you sometimes experience shortness of breath for no apparent
reason? |
yes/no |
2 |
| |
|
|
|
| |
Have you taken any of the following drugs: (1 point for low usage,
3 points for high usage) |
|
|
| 27 |
Prescription
Drugs |
yes/no |
1-3 |
| 28 |
Pain killers/Tranquilizers |
yes/no |
1-3 |
| 29 |
Psychiatric
Drugs |
yes/no |
1-3 |
| 30 |
Ritalin |
yes/no |
1-3 |
| 31 |
Over the counter drugs?(aspirin, etc) |
yes/no |
1-3 |
| 32 |
LSD |
yes/no |
1-3 |
| 33 |
Heroin |
yes/no |
1-3 |
| 34 |
Cocaine |
yes/no |
1-3 |
| 35 |
Pot |
yes/no |
1-3 |
| 36 |
PCP |
yes/no |
1-3 |
| 37 |
Methadone |
yes/no |
1-3 |
| 38 |
Steroids |
yes/no |
1-3 |
| |
|
|
|
| |
|
|
|
| |
Sum up the points for the questions where you answered "yes": |
|
|
| < 10 points |
You may have a very low level
of toxicity in your body |
|
|
| 10 to 25 points |
You may have levels of toxicity in your body which could reduce
your ability to feel alive and think clearly |
|
|
| 25 to 40 points |
You may have a level of toxicity in your body sufficient to cause
you to feel lifeless and dull |
|
|
| 40 to 50 points |
Could indicate a high level of toxicity in your body |
|
|
| > 50 points |
You could be experiencing extreme body toxicity which could reduce
the length as well as the quality of your life. |
|
|